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SITE ADDRESS: 03(4�l`'L
<br />, teil.d It, ' ( (/ l
<br />- `� PERMIT
<br />1, the OwnerlApplicantlLicensed Well Driller/Pump Contractor agrees to indemnify, defend with counsel reasonably approved by County, and hold harmless
<br />the County and its officers, officials, employees, agents, boards, and commissions (collectively "County') as follows:
<br />Indemnity_
<br />3. From and against any and all claims, demands, actions, proceedings, lawsuits, losses, damages, judgments and/or liabilities arising
<br />out of, related to, or in connection with the application and applied for well or pump or to attack, set aside, void, or annul, in whole or in
<br />part, approval or denial of the applied for permit by the County, and any environmental review documents related to the applied for
<br />permit,,
<br />b. For any and all costs and expenses incurred by the County an account of any Claim, except where such indemnification is prohibited
<br />by law, including but not limited to damages, costs, expenses, attomey's fees, or expert witness costs that may be asserted by any
<br />person or entity, private attorney general fees claimed by or awarded to any party against the County, and the County's costs incurred
<br />in preparing an administrative record which are not paid by the petitioner.
<br />a Except as to the County's sale negligence or willful misconduct
<br />Defense-,
<br />a. The County may participate or direct the defense of any Claim_ The County's actions in defense of any claim shall not relieve me of any
<br />obligation to indemnify, defend, arid hold harmless the County.
<br />b. In the event of a disagreement between County and me regarding defense of any Claim, the County shall have the authority to control
<br />the litigation and make litigation decisions, including, but not limited to, the manner in which the defense is conducted_
<br />If County reasonably determines that having common counsel presents such counsel with a conflict of interest or if I fail to promptly assume the defense of
<br />any Claim or to promptly employ counsel reasonably satisfactory to the County, then County may utiive the Office of the County Counsel or employ
<br />separate outside counsel to represent or defend the County, and I shall pay the reasonable attorneys' fees and costs of such counsel.
<br />1 HERESY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN
<br />JOAQUIN COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS
<br />CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICFENSE BOARD AND THAT I AM IN COMPLIANCE VATTH ALL
<br />WORKERS COMPENSATION LAWS_ �
<br />PROPER7YOWNER: / _
<br />...
<br />AUTHORIZATIONTOR OTHER THAN C-57 SIGNING PERMIT APPLICATION
<br />hereby authorize
<br />Nam -of CfiI U—cd Assti:ofiztd rtep=-tame PrincM�mc-o£,authoirzctl Erni
<br />to sign- this San Joaquin County WeII & Buliag Permit Application on my behalf. I understand this autborization is valid for one year and
<br />is limited to the work plan dated on the front page of this application.
<br />ERDO43-06 IW25i2O2i Pige2 of 2 Well /Pump Perm -it
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